Cleveland-based University Hospitals Health System is a private, not-for-profit academic health system with 150 inpatient and outpatient locations throughout northeast Ohio. It provides care to more than 120,000 surgical patients annually in 2,240 beds and 128 multispecialty operating rooms across 21 hospitals and four ambulatory surgery centers.

THE PROBLEM

The rapid growth University Hospitals had experienced through acquiring existing hospitals and opening new facilities was great for its ability to provide quality care across northeast Ohio, but it also left the health system somewhat disconnected from facility to facility.

One major issue it faced was inconsistent goals across operating locations. Perioperative leaders each had goals of increasing volume and utilization, but their distinct strategies and tactics were not optimally aligned for the success of the health system as a whole.

For example, programmatic growth across hospitals was managed at the local level and did not incorporate the health system's utilization strategies and goals. 

Furthermore, some hospitals had their own unique performance-measurement methodologies, so University Hospitals could not easily determine how it was performing across the entire system, which impeded strategic planning abilities.

"In order to monitor and optimize perioperative performance, we needed to align leadership at the hospital level to system-wide initiatives and standardize management practices across all facilities," said Dan Towarnicke, vice president of perioperative services at University Hospitals Health System. "A higher level of 'systemness' would allow us to leverage the breadth of resources throughout our entire system."

Specific issues University Hospitals wanted to address included the ORs at University Hospitals Cleveland Medical Center, the main campus, which were 95% blocked simply because that's where the majority of surgeons were located. The convenience of the location for those surgeons led to a lot of lower acuity procedures being performed in the main hospital, which is where most of the acute cases needed to be seen.

University Hospitals Cleveland Medical Center also is a Level 1 trauma center and the health system needed to keep capacity available for a high volume of urgent and emergent cases, which could be disruptive to the block schedule.

"The average release time for blocks now is 19.5 days, and decanting lower acuity cases to ASCs enabled us to improve our CMI surgical acuity index at UH Cleveland Medical Center from 3.38 to 3.53 over the past few years."

Dan Towarnicke, University Hospitals Health System

"We also needed to improve our ability to collect and analyze data because we had a time-consuming, manual reporting process," Towarnicke said. "With different facilities having different KPIs and methodologies, surgeons wouldn't always trust the performance data they were shown.

"This created conflicts when we wanted to rearrange the block schedule and take time away from people, particularly because we lacked transparency of block allocation across the system with limited visibility into available times or workflows to easily request that time," he added.

PROPOSAL

University Hospitals was looking to empower its clinicians with new processes and new technology to improve care quality and reduce inefficiencies. It recently established a surgical governance committee that sets strategy and provides oversight while a system OR ops committee executes the strategy and ensures process adoption across all campuses.

To achieve this, the health system also needed a digital platform to provide predictive analytics, streamlined workflows and transparent data.

Hospital IQ, a predictive operations software vendor, offers an artificial intelligence-enabled operations management platform to streamline workflows, increase access and insight to OR time, and deliver transparent, trusted data directly to stakeholders. The vendor caught Towarnicke's eye.

"Hospital IQ's perioperative solution, specifically, delivers prescriptive recommendations and AI-enabled workflows that enable us to increase surgical volume, increase system-wide OR utilization and case mix, increase surgeons' access to OR time, and improve quality of care," he said. 

"It also predicts future patient demand to enable proactive planning and better alignment of staff to demand by integrating machine learning-based AI and forecasts with our own data collected across our health system.

"Predicting and prioritizing daily variability allows our leaders to significantly improve staffing strategies and resource planning to better match to the current case schedule and expand capacity to support growth," he added.

MEETING THE CHALLENGE

The vendor not only provided insight to the health system's current operations, it also helped unlock the strategies and tactics the health system laid out in its planning. The platform helped University Hospitals transform how it uses and plans in the OR suite, enabling the provider organization to achieve Towarnicke's so-called "systemness" across the entire health system.

"Strategically, Hospital IQ makes it possible to manage a suite of rooms independently, while still rolling up to system-wide goals and directives," Towarnicke explained. "We also can decant lower acuity cases to ambulatory centers, which boosts efficiency at those locations while at the same time opening up the capacity we needed at UH Cleveland Medical Center for high acuity and emergent cases.

"The optimized resource planning and staff scheduling that the vendor enables also helps us control costs and reduce waste by better aligning resources to demand," he added.

Tactically, the platform prompts blockholders to release time that is predicted to go unused and makes available OR time visible to all stakeholders across all facilities. OR time that previously went unused now is being uncovered and captured. The vendor's system makes it easy for surgeons to view and request time, and for OR schedulers to review and approve requests, Towarnicke noted.

The visibility and access to any OR in the system gives the health system a competitive advantage with its community surgeons who were looking for more OR time, he said.

"Hospital IQ also provides trusted, transparent, easily accessible data that gives us timely performance metrics we need for staying on track or correcting course," he said. "Our EHR is Allscripts, but we have many other sources of information as well, and Hospital IQ seamlessly integrates with all of them to become the single source of truth we needed."

RESULTS

The vendor's AI-enabled technology transformed the way University Hospitals manages scheduling, resulting in increased OR utilization, higher case volume and overall savings, Towarnicke reported. Improvements were quickly realized by specific units in the hospitals, like the OR and perioperative suites, and across the full enterprise, as well, he added.

"Streamlined operations, aligned goals and cross-enterprise visibility enabled the transformation of our surgical operations for optimized OR utilization and scheduling, among other improvements," he said. "Blockholders released 2,460 OR hours in the first four months of 2021, and that unhidden time has been used to perform an additional 415 cases.

"Overall OR utilization has increased by 5%," he continued. "The average release time for blocks now is 19.5 days, and decanting lower acuity cases to ASCs enabled us to improve our CMI surgical acuity index at UH Cleveland Medical Center from 3.38 to 3.53 over the past few years."

ADVICE FOR OTHERS

"It's nearly impossible to achieve meaningful improvements in perioperative performance without accurate data," Towarnicke noted. "We recommend not to let the fear of replacing outdated systems keep you from achieving better operations and delivering better healthcare. Start by assessing the processes currently in place and how your organization is using its data.

"When looking at our processes to meet hospital-specific goals at University Hospitals, we saw a disconnect in our strategy and execution that ultimately challenged our teams even more," he continued. "There was no reliable source for data-driven insights or a single source of truth, which caused confusion and disparate operations."

While trying to address numerous problems at once can seem overwhelming, keep in mind that every inefficiency ties back to how one operates, he advised.

"So prioritize the area that is most in need of streamlined, intelligent automation and work your way out," he said. "The combination of the right people with the right processes and the right technology is game-changing.

"With plans and goals, and the people in place, we were only able to move forward when we added the technology component," he concluded. "Tackling specific business units or issues to begin operational transformation will give your team time to adjust and learn the new platform, which in turn will help align future transformation strategies and approaches across the enterprise or health system down the line."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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